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Health Assessment > Lecture 9.1 - Neurological System > Flashcards

Lecture 9.1 - Neurological System Flashcards

1
Q

After what age is there a steady loss of neurons?

A

After 65 years

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2
Q

What does the neural atrophy caused by aging do to the rest of the body?

A

–> Loss of muscle strength and bulk
–> Loss of tone around face/neck/spine
–> Impaired fine motor coordination
–> Decreased reaction time
–> Loss of senses (Touch, pain, taste, and smell)
–> Loss of sense of vibration in ankle, absence of Achilles reflec

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3
Q

Why are older adults predisposed to falls?

A

Loss of muscle strength and tone, as well is dizziness and loss of balance contributes to more incidence of falling
–> Loss of short term memory also results in forgetfulness about injuries

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4
Q

What might lead to an epilepsy diagnosis?

A

More than two seizures in 24 hours

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5
Q

What is dysmetria?

A

Loss of coordination

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6
Q

What is senile tremor?

A

A slight tremor or shake that is normal in many elderly individuals.

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7
Q

How is Cranial Nerve 1 tested? Is this a part of routine practice?

A

Check patients sense of smell
–> Check only if you suspect issue

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8
Q

How is cranial nerve II tested?

A

With the Snellen Chart and a peripheral vision field test.

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9
Q

how is are cranial nerves III, IV, and VI tested?

A

Test 6 cardinal fields of gaze, check convergence and accommodation.
Inspect pupil size, shape, equality, and light reflex.
Inspect palpebral fissures.

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10
Q

How is cranial nerve V tested for?

A

Palpate mastication of muscles while clenching teeth
Check sensation on forehead, cheeks, and chin
Corneal test only if you suspect issue.

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11
Q

How should a corneal test be conducted?

A

With an eyedrop.
–> Used to be checked with a tissue or gauze, but this cause microscopic lesions on the cornea and it cannot be donated.

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12
Q

How is cranial nerve VII tested?

A

Examine mobility of face while making facial expressions
Check taste only if you suspect issue

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13
Q

How id cranial nerve VIII tested?

A

Whispered voice test and Romberg test

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14
Q

What is the Whispered Voice Test?

A

Whispered a sequence of letters/numbers at about arms length from patient.

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15
Q

How are Cranial Nerves XI and X tested?

A

Examine pharyngeal movement when saying ‘aaaah’
Smoothness of voice when talking
Gag reflex - done only of necessary
Taste - done only if necessary

+ Check ROM and strength of trapezius and sternomastoid

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16
Q

How is cranial nerve XI tested?

A

Test ROM and strength of trapezius and sternomastoid

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17
Q

How is cranial nerve XII tested?

A

Examine tongue tone, bulk, and movement
Listen for clarity of speech

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18
Q

What is tandem gait?

A

Walking heel to toe, as if on a tightrope

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19
Q

What is the one leg hop? When should a shallow knee bend be used instead?

A

Used to assess balance.
Use shallow knee bend on elderly individuals to prevent falls/injury

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20
Q

What is the Romberg test?

A

A test used to determine balance.
Ask patient to stand upright with eyes closed for 20 seconds.

Some swaying is normal, but patient should not fall over.

21
Q

Which coordination tests should be performed on someone during a motor assessment?

A
  1. Rapid alternating movements
    —> Flip hands quickly on legs
  2. Finger to nose test
    –> (eyes closed)
  3. Finger-to-finger
    –>E.T
  4. Heel-to-shin
    –> Can be done laying or sitting
22
Q

How can the spinothalamic tract be tested?

A

–> Pain
–> Temperature (only if necessary)
–> Light touch

23
Q

How can the posterior column tract be tested?

A

–> Vibration
–> Position
–> Tactile Discrimination

24
Q

How can we test for perception of pain?

A

Sharp or dull test

25
Q

How can we test for light touch perception?

A

With a wisp of cotton or tissue

26
Q

How do we test for perception of vibration?

A

Hold tuning fork over bony prominences and ask pt to tell you when it starts and stops

27
Q

How can we test for kinesthesia?

A

Move pt’s finger up and down (hold sides) with their eyes closed. Ask them to tell you if it has moved up or down.

28
Q

What is stereognosis?

A

The ability to identify objects by touch

29
Q

What is graphaesthesia?

A

The ability to read a number traced on the skin

30
Q

What is extinction in the context of tactile discrimination?

A

The inability to perceive multiple stimuli of the same type simultaneously.

31
Q

What is point location?

A

The ability to point to a spot where touch was felt

32
Q

How are deep tendon reflexes graded?

A

0 - no response
1+ - Diminished, low normal
2+ - Normal, average
3+ - Brisker than average, may indicate disease
4+ - Very brisk, hyperactive with clonus. Indicative of disease

33
Q

How are the bicep reflexes tested?

A

Support forearm and hold thumb on bicep tendon.
Strike thumb, observe forearm flexion.

34
Q

How are triceps reflexes tested?

A

Suspend upper arm and strike triceps tendon directly. Observe forearm extension.

35
Q

How is the Brachioradialis tendon reflex observed?

A

Suspend forearm by holding pt’s thumbs. Strike forearm directly, 2-3 cm above radial styloid process. Observe flexion and supination of forearm.

36
Q

How do you elicit the patellar/quadricep reflex?

A

Allow lower leg to dangle and strike tendon directly, just below patella. Observe extension of lower leg.

37
Q

How do you elecit the Achilles reflex?

A

Knee should be flexed and externally rotated, hold foot in dorsiflexion. Strike Achilles tendon directly, observe plantar flexion.

38
Q

How is abdominal reflex elicited?

A

Lie patent supine with knees bent. Stroke skin with reflex hammer from lateral abdomen to midline. Observe ipsilateral contraction of abdominal muscles and deviation of umbilicus toward stroke.

39
Q

How is the plantar reflex elicited?

A

Patient should lie in slight external rotation. Stroke the lateral side of the sole of foot in upside down J formation. Observe plantar flexion.

40
Q

Which cranial nerves become reduced in older adults?

A

VII, IX, X and I
(taste and smell)

41
Q

Which reflexes are lost in older adults?

A

Loss of Achilles reflex, all deep tendon reflexes are less brisk.
Absent plantar & superficial abdominal reflexes

42
Q

What is Dyskinesia?

A

Involuntary erratic movements
–> Shakes, tics, and tremors.

43
Q

What is muscle flaccidity? What kind of injury/condition is it associated with?

A

Decreased Muscle tone, weakness and fatigue - associated with lower neuron injury

44
Q

What is muscle spasticity? What kind of injury/condition is it associated with?

A

Increased muscle tone and resistance to passive strengthening. - associated with upper neuron injury

45
Q

What is muscle Rigidity? What kind of injury/condition is it associated with?

A

A constant state of resistance - associated with injury to extrapyramidal motor tracts (such as basal ganglia)

46
Q

What is cogwheel rigidity? What kind of injury/condition is it associated with?

A

A type of rigidity in which increased tone lessens by degrees during passive ROM, feels like small, regular jerks - associated with Parkinsonism.

47
Q

What is Multiple Sclerosis? What are its symptoms?

A

MS is a chronic, progressive, autoimmune disease where axons become inflamed, demyelinated, degenerated, and undergo sclerosis.
Symptoms include blurred vision, diplopia, extreme fatigue, weakness, spasticity, numbness, tingling, loss of balance.

48
Q

What is paraplegia?

A

Lower motor neuron damage due to spinal cord injury

49
Q

What are the stages of paraplegia?

A

Initial spinal shock - no movement or reflexes below lesion
Gradual return of deep tendon reflexes –> Flexor spasm –> Extensor Spasm –> Extensor tone

Health Assessment (14 decks)

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